Brandon Robert Ditullio, MS., BCBA, LABA.

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

2516 Issued in MA

Practice address

345 Greenwood St Ste a
Worcester, MA 01607-1767

Phone

(508) 363-0200

NPI assigned

Feb 1, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 7

Other names 1

• Brandon Ditullio Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Edinburg Center Inc

  • Psychiatry Physician
  • Bedford, MA
  • NPI 1073617353
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1328054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546819200000",
    "number": "1831461151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 BURLINGTON RD",
            "city": "BEDFORD",
            "state": "MA",
            "postal_code": "017301406",
            "telephone_number": "781-862-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 GREENWOOD ST STE A",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016071767",
            "telephone_number": "508-363-0200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "205 Burlington Rd",
            "address_purpose": "LOCATION",
            "city": "Bedford",
            "state": "MA",
            "postal_code": "017301406",
            "country_code": "US",
            "telephone_number": "781-862-3600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DITULLIO",
        "first_name": "BRANDON",
        "middle_name": "ROBERT",
        "name_prefix": "Mr.",
        "credential": "MS., BCBA, LABA.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-02-01",
        "last_updated": "2019-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MA",
            "license": "2516",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MBHP",
            "identifier": "1303287",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NHP",
            "identifier": "1004745",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "M18633",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BMC",
            "identifier": "0000023532",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1303287",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "042611055",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NETWORK HEALTH",
            "identifier": "99618201",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRANDON",
            "last_name": "DITULLIO",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Behavior Analyst in Worcester, MA
• Providers in Worcester, MA by specialty
• Behavior Analyst in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.